Gender and Reproductive Health – Tibetans in Tibet and in India

By Tenzin Tseyang

Reprinted with permission from author’s blog

“I know I will die. Many of my friends like me died” wept my newly arrived Tibetan cousin from Tibet as the doctor in Dharamsala, India suggested her to undergo a surgery because the “Copper T” that has been forced in her body by Chinese health workers in Tibet, needs to be removed (May 2007).

 According to her, the Chinese Health officials in Medrogongkar, Tibet, forced her to undergo “Copper T” sterilization as soon as they learned that she had two children. This is a grave concern for Tibetan women in Tibet but how about Tibetan women in India? “I recalled an incident about my neighbor who was pregnant and was kicked on her belly by her own husband in India”. These two incidences suggest that the reproductive and sexual health rights of Tibetans both in Tibet and in India are areas of concern that needed to be studied and addressed.

Tibet’s history, especially with China is an inseparable part of discourse to understand any development issues that concerns Tibetan population. The Chinese occupation in Tibet that began in 1950s took over entire Tibet by 1959. Following this the Dalai Lama escaped to India with some government officials and some other thousands of Tibetan people (Sam, 2009). Since then many Tibetans resettled themselves in different states of India after the then Prime Minister of India, the late Pandit Jawaharlal Nehru, warmly welcomed the Dalai Lama and people. Many Tibetans continued to escape Tibet crossing the borders and risking their lives but many remained in Tibet.  There is 127,935 Tibetans outside Tibet and out of them 94,203 live in India. Women constitute 44% of the Tibetan population in Exile. However, majority of the Tibetans still continue to live in Tibet (The Planning Commission, CTA 2009, p.19).

There are difficulties to study Tibetan demography and especially Tibetan women population relying on Chinese government’s reports because China excludes many former Tibetan states like Qinghai. Gansu, Sichuan and Yunnan from Tibetan Autonomous Region (Fischer, 2008) Another challenge to study the Tibetan population in Tibet is that the Han Chinese have outnumbered Tibetans in Tibet’s major cities, towns and few rural counties. Moreover, discussing Tibetan women, Sam (2009) observes that there is no account of Tibetan women in Tibet’s stories. However, I must add that although there are but there are very few.

Therefore, studies and records are on status of Tibetan women in Tibet and in exile is important part of the discourse regarding plight of Tibetan people. The comparison study will look into a brief picture of women’s reproductive health hardships since 1959 and will also document how China’s demography is impacting women in and out of Tibet. It also will study some of the agents trying to bring in change for Tibetan women in these two countries.


There are several reasons that make the study of Tibetan women in Tibet and India indispensably important. Firstly, Tibetan women inside Tibet belong to ethnic minority groups under China while Tibetan women in India lacks of citizenship. Secondly, Tibetans are no exception when it comes to gender inequality. For instance there is a debate over the very word for Tibetan women, which is “skyedman” meaning lower birth. However, many defenders are trying to modify the term by arguing that this is not true, the spelling is “skyedsman” a change from “dman” meaning inferior to “sman” meaning medicine. Sam (2009) also recalls that the word women in Tibet meant “lower birth” and many Tibetan women pray to be born as male in their next life. Sam also shares account of Tibetan women interviewees who recall their experiences during this gray historical moment in 1959. One Tibetan woman shared her story that she was then at last stage of her pregnancy but had to be in the city of Lhasa witnessing the Chinese troops firing and bombing which lasted two and a half days while her husband was away to protect his people. Soon after two days, she gave birth to her sixth baby. Imagine, how many more Tibetan women had gone through such situations but sadly, are undocumented. Thus these critical facts call attention to study gender and reproductive health status of Tibetan women.

Today, Tibetans both in and outside Tibet may not be experiencing as critical reproductive health as early post conflict or displacement period. However, there are many social issues that are leading to low reproductive health status of Tibetan women such as increasing prostitution that is arising from socio-economic status in Tibet. Sam (2009) writes on her revisit to Tibet recently, there are brothels that look like teahouses where both Tibetan as well as Chinese girls will be found as prostitutes. While a Chinese prostitute may earn 100 Yuan (Chinese Currency), Tibetan prostitute are exploited at a price equivalent to a bowl of noodles. This is because the Tibetan ethnic groups are considered as rural and uneducated in Tibet. Sam’s description implies that there are no safety measures for Tibetan prostitutes. Such racial discrimination against Tibetans places Tibetans on a disadvantaged position regarding reproductive health of Tibetan women.

Now, to compare this situation to Tibetan women’s situation in India, Tibetan women’s status can be comparatively better, although there are no particular studies that had been carried out to learn this comparative vulnerability of Tibetan women in India. There is a major concern that there are increasing number of Tibetan women in prostitution in metropolitan cities of India like New Delhi and Bangalore. This concern was strongly voiced by Tibetan women and men when I conducted a workshop to create “Public Awareness” on Women in New Delhi in March 2013 (CTA 2013). They added these women are young college girls from poor Tibetan settlements with low economical background or young women from Tibetan settlements looking for a job. Many of them tend to end up in prostitution because of scarcity of jobs available to them. There also is a practice of watching out for prostitutes in the evening in New Delhi for prevention. Preventing prostitution is not the only solution but helping them for good health and safety is another solution, which is hardly discussed.

Women’s education and awareness enable them to protect her and stand up for other women, regarding her sexual and reproductive health rights. To begin formal academic education in Exile, the CTA (2009) reports that female illiteracy rate is 33.1%, which is higher than male’s being 19.5% (p. 40). Literacy is a skill that can enable one to access health information and more Tibetan women lack that. In one of my early field experience in 2006, I observed some Tibetan women are too shy to answer questions regarding contraception and reproductive health. Such shyness is not only unhealthy for a woman to protect her own reproductive health rights but can be a great obstacle for building her information and awareness. Lack of awareness regarding the concept of marital rape is another concern. These are some indicators that there is a lack of strong education and awareness on reproductive and sexual health rights that can protect them.

The Phayul (2013)’s report on CHOICE, a Tibetan Non Governmental Organization that works solely on HIV/AIDS came across 118 Tibetan people living with HIV/AIDS out of which 17 died. There is no gender segregation in the data provided. In addition, CTA (2004), writes that 45% of the respondents in one of its survey, are not aware of HIV/AIDS. Prior to 2008, I have come across friends who have great stigma towards people living with HIV/AIDS. They think people living with HIV/AIDS are the ones who had been more active in sexual activities and overlook other factors that may cause this disease. This may create more difficulty for an individual to check and seek treatment regarding such diseases. Therefore opening discussions on such topics is highly needed.

However, the status and situation differs for Tibetan women in Tibet. Although there is not much literature that discusses literacy rate of Tibetan women in Tibet as Tibet ethnic composition today is mixed with many other ethnic groups. However, Fischer (2005) finds that illiteracy rate amongst Tibetans in Tibet is 85% and only 15% are literate. Further studies shows that this 15% of educated groups are mostly from urban areas. Subsequently, Yeshi, Wangdui &Holcombe (2009) describes that the literacy level in Tibet especially the rural area is very low. They also express their observation that Tibetan women in Tibet are shy and awareness on reproductive health is low. Shyness and illiteracy therefore can be

There are rare studies about prevalence of HIV/AIDS. International Campaign for Tibet reports that in Chinese government accounts that there are 41 cases of people living with HIV/AIDS in 2007. However, Tibetan people inside and outside are concerned that the railway track that China constructed from Golmud (China) to Lhasa (capital Tibet) can increase the risk of these diseases. Fischer (2008) points out that there is an increase in Han migrants who come into Tibet on daily basis; these migrants are disproportionately males except for many Chinese sex workers who come into the area. These male migrants usually look for sex workers. This is a risky population and behavioral exchange that can trap economically poor Tibetan women in Tibet to transmit HIV/AIDS as it has been already seen that Tibetan prostitutes are much cheaper in price. International Campaign for Tibet (2008) also points out that there is an increase in prostitution, an increase in drug smuggling as well as human trafficking after the operation of Golmud Lhasa train. Probably it is because of high prevalence of HIV/AIDs that Yeshi, Wangdui &Holcombe (2009) also write about their project that conducted trainings for behavioral change and included awareness on HIV/AIDS in the region. Prevalence of HIV/AIDS amongst Tibetan women in either country will continue as there is continuous cross border migration from Tibet to India and India to Tibet.

Fertility rate and maternal mortality rate are another indicators of women’s reproductive health. Fischer (2008) examines Chinese data and reports that the total fertility rates in TAR (which excluded Qinghai, Sichuan, and Yunnan because China insist TAR is Tibet) over the time period is “5.5 births per woman in 1968, 5.0 in the 1970s & 1980s, and fell sharply later”. This is an impact because of China’s one child policy implementation in China and Tibet. Although China claims that there is a lax for minority people regarding number of childbirth, which is two, but it applies only for urban and not rural. China introduced this lax in 2000 partly because of China’s bigger demography concern. This policy is an issue for Tibetan women primarily because of the forced abortion and sterilization, which are usually unsafe. Fischer (2008) also writes that China has taken forced birth controls majorly in 1980s and 1990s and especially in Tibetan regions outside TAR. However, my cousin was sterilized forcefully in the mid 2000s, which is an indicator that Chinese health officials had been practicing forced sterilization even in year 2000’s. According to China’s most recent data, fertility rate amongst Tibetan women is 1.9 per woman in TAR, 1.7 in Malho and Tsolho (Tibet) and 1.8 in Tsojang. This is a dramatic fall since 1968.

Another indicator can be the question of mother’s health. Fischer (2008) reported that officially UNICEF recorded that maternal mortality is 400 per 100,000 child births in Tibet while his interviewees who are working there unofficially from international non governmental organizations claimed that the rates of maternal mortality were double the UNICEF report. Therefore, it can be assumed that the maternal mortality rate in Tibet is 800 per 100,000 childbirths.

The Tibetan Women’s Association (2005) quotes the Planning Commission that the fertility rate in 1980s was 4.9, 1990s 3.9 late 1990s is 2.6 which indicates that it had been declining. Hypothetically, it can be assumed that until 1980s, the popular Tibetan Buddhist values that beliefs like contraception, sterilization and abortion are sins because these actions threatens newborns life. Today, there is a shift in these beliefs in most of the Tibetan community except for rare Tibetan settlements where people still think that contraception and sterilization is sinful. The Planning Commission, CTA (2009), reports that the fertility rate of Tibetans in Exile has fallen from 1.22 births each woman in 1998 to 1.18 in 2009. Unfortunately, there is no information on maternal mortality.

Gender Based Violence (GBV) against women always indicate a low reproductive health status because it indicates that women are being controlled and are not given autonomy to make important decisions themselves including their reproductive rights. Unfortunately, Tibetans in India observe increasing levels of violence against women recently.  For instance the Tibet Sun (2014) writes that a cook from Tibetan Children’s Village school was arrested for raping a 13-year-old minor Tibetan girl. New Indian Express (2014) highlighted a case that happened in August 2014 when a Tibetan nurse was gang raped in New Delhi by two Indian men. The Tibetan Women’s Association (2005) has noted that 3.2% of research respondents have experienced domestic violence (p. ). Tibetan women in India are vulnerable to both Tibetan and Indian men. Similarly in Tibet, Tibetan women also go through series of GBV from her own Tibetan family or from the Chinese officials if they end up in prisons. Lhamo (n.d) writes about cases of some of the political prisoners that she knew. She said that even if political prisoners are nuns they are sexually harassed, abused and beaten. Such harmful practices will definitely prove harmful for a woman’s reproductive and sexual health.


There are many health related issues, which are socio-political and economical, and need to be addressed. For population in Tibet, there had been some organizations that had been working voluntarily like Kunde Foundation, Tibet Poverty Alleviation Fund (TPAF), Ford Foundation as funder, PATH and USAID. However, recently the Chinese government discouraged NGOs and INGOs to function in mainland Tibet. Fortunately, for Tibetans in India, there is no restriction on International donors and organizations supporting reproductive health programs in India. The Mother and Childcare program under Department of Home, the Women’s Empowerment Desk of Central Tibetan Administration, the Tibetan Women’s Association, Kunphen are some of the governmental and non-governmental organizations that are carrying their programs in the field to improve Tibetan Women in India’s reproductive health.

The reproductive and sexual health status for women in Tibet as well as India is not encouraging and there are many works that needs to be done. There is a need for further and deeper studies regarding reproductive health status in Tibet and mainstream it into Sino-Tibet dialogue. The organizations in Exile will continue their present efforts to advance women’s reproductive health. The gender and reproductive health status is vital for Tibetan Women and men’s health. Tibetans must work on advancing gender and reproductive sexual health more than ever.


Demographic Survey of Tibetans in Exile-2009. (2009). PLanning Commision, CTA, 1-108.

Fischer, A. M. (2008). Population Invasion Versus Urban Exclusion in the Tibetan Areas of Western

China. Population and Development Review, 34(4), 631-662.

Ford, J. (2014, August 18). Prejudice, exclusion and sexism is all part of life for a Tibetan

migrant in Beijing. Retrieved March 8, 2015, from


Programme on Women’s Empowerment held in Ravangla. (2013, March 6). Retrieved March 8, 2015, from

Central Tibetan Administration website:


Sam, C. (2009). Sky Train: Tibetan Women on the Edge of History. USA, Seattle and London: Universtiry of Washington Press.  Status of Exiled Tibetan Women in India, 2005.Tibetan Women’s Association, 40-44

Yeshi, C., Wangdui, P., & Holcombe, S. (2009). Health and Hygiene Behaviour Change: Bottom-UP meets      Top Down in Tibet. Development in Practice,19(3), 396-402.


Written by: Tenzin Tseyang

Acknowledgement: Edited by Lois A Herman

Photo Credit: Jan Reurink (through flickr)

Contact me: [email protected]

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